Self-Service Terminal Feedback Form Are you a BIBD customer? / Adakah awda pelanggan BIBD? Yes No Full Name / Nama Penuh IC Number / Nombor Kad Pengenalan Contact Number / Nombor Untuk Dihubungi Date of Transaction / Tarikh Transaksi Time of Transaction / Masa Transaksi Location / Lokasi Brunei International Airport Berjaya Tutong BIBD Connects BSB BIBD Connects Lambak BSP HQ Panaga Bunut Petrol Station Grand City Hotel Hua Ho Mulaut Hua Ho Tutong Jerudong Filling Station Jerudong Park Medical Centre KB Sentral Kiulap Branch Kowira Berakas Garrison Kuala Belait Branch Mail Processing Centre Old Airport Main Branch BSB Manggis Branch Mentiri Branch Ministry of Finance & Economy Building Muara Branch NEXGEN Branch Mall Gadong OneCity Shopping Centre Panaga Branch Rimba Branch RIPAS Hospital Sengkurong E-Branch Seri Branch Seria Branch Serusop Branch Soon Lee Megamart Sg Liang Soon Lee Megamart Lambak Soon Lee Megamart Pandan KB Supasave Beribi Supasave Mabohai Tanjung Bunut Branch Temburong Branch The Core, UBD Times Square Shopping Centre Tutong Branch Yayasan Shopping Complex Machine ID (as stated in the QR code) / ID Mesin (seperti tertera di Kod QR) Type of Error or Machine Fault / Jenis Kerosakan atau Kegagalan Mesin Cash not dispensed / Wang tunai tidak dikeluarkan (ATM) Card retained / Kad tertahan (ATM) Deposit unsuccessful / Simpanan wang tidak berjaya (CDM) Machine error or unavailable / Mesin tidak berfungsi (ATM/CDM) Cash wrongly dispensed / Jumlah wang tunai salah dikeluarkan (ATM) Receipt paper out / Kertas resit habis (ATM/CDM) Other / Lain-lain For Other, please provide details below: / Untuk Lain-lain, sila nyatakan di bawah: Amount (BND) - only for Cash Not Dispensed (ATM), Deposit Unsuccessful (CDM), Cash Wrongly Dispensed (ATM)Jumlah (BND) - hanya untuk Wang Tunai Tidak Dikeluarkan (ATM), Simpanan Wang Tunai Tidak Berjaya (CDM), Jumlah Wang Tunai Salah Dikeluarkan (ATM) For CDM errors, please state Cash Denomination (B$500, B$100, B$50, B$10, B$5 or B$1) Untuk Kerosakan CDM, sila nyatakan Denomisasi Wang Tunai (B$500, B$100, B$50, B$10, B$5 atau B$1) I have read and understood the terms outlined in BIBD's Online Privacy Policy. / Saya telah membaca dan memahami terma yang digariskan dalam Dasar Privasi Dalam Talian BIBD. I consent to the processing of your personal data in accordance with the terms set forth in the abovementioned policy. / Saya bersetuju dengan pemprosesan data peribadi mengikut terma yang dinyatakan dalam dasar tersbut Send